Bedside Shift Reporting: Improving Nurse Handoff Communication

Introduction

Nurse handoff communication during shift change is one of the most frequent yet critical nursing duties, providing the basis for delivering safe, reliable care (Eggins & Slade, 2015). Research reveals that ineffective nurse communication at the time of patient handoff is a primary cause of sentinel events (Drach-Zahavy & Hadid, 2015; Eggins & Slade, 2015). The WHO (World Health Organization), AHRQ (Agency for Healthcare Research and Quality), and other health organizations recognize the significance of addressing risks to patient safety linked to ineffective handoff communication. Together with the National Patient Safety Goals (NPSG) for improving the efficacy of communication among caregivers, these organizations have put forward recommendations for improving upon this problem (Drach-Zahavy & Hadid, 2015).

North Caroky Hospital is a small 35-bed community hospital employing twenty 12-hour night shift nursing personnel. The hospital nurses' failure to provide quality Bedside Shift Reporting (BSR) can, to a great extent, adversely influence patient outcomes. Ineffective communication can cause treatment delays or the administration of incorrect treatment, needless preventable expenses, unplanned extension of hospitalization duration, lower personnel and patient satisfaction rates, and, ultimately, harm to the patient (Drach-Zahavy & Hadid, 2015). This paper discusses a focused, evidence-based project that attempts to improve BSR quality among those twenty 12-hour night shift nursing staff in the hospital's medical-surgical division by implementing a standardized instrument for BSR, targeted at improving the quality of communication among nursing personnel and avoiding clinical errors.

Clinical Leadership Theme and Organizational Problem

Some of the themes for improving clinical leadership identified in the course of this project are patient safety, employee and patient satisfaction, and employee communication. A broad theme statement for the project may be stated as follows: the hospital endeavors to enhance the quality of handoff communication during shift changes in the medical-surgical division by implementing a standardized instrument for BSR. This instrument addresses five major nursing behaviors: introduction, preparation, exchange of information, safety examination, and patient participation. The process commences with appropriate preparation of incoming nurses and culminates in steady, high-quality BSR delivery without miscommunication that could harm patients. The project is anticipated to: (1) enhance patient safety; (2) increase employee and patient satisfaction; (3) improve nurse–patient communication; and (4) prevent needless hospital expenses. These efforts are imperative given the identified needs: improving patient safety through better communication, increasing employee and patient satisfaction, and averting communication errors during shift change.

This BSR project covers the CNL (Clinical Nurse Leader) curricular component of managing the care environment. It aims to bring about improvements in patient safety and satisfaction and to reinforce collaboration by improving the communication process at the time of shift change in the orthopedic division. CNL roles responding to this project are Team Manager, Information Manager, and System Analyst.

Description of the Organizational Problem

The issue identified at the hospital is inadequate communication among nursing care workers while verbally reporting to peers at the time of shift change. For improving nurse-to-nurse and nurse-to-patient communication, thorough bedside reporting during shift change is necessary. Such a move will improve patient satisfaction and outcomes and communication among nursing staff, while promoting patient participation in their respective care plans.

Patient handoff may be defined as the transfer of patient care between two care providers. During this transition, patients are at maximum risk of suffering communication-related errors. Observations of the targeted clinical microsystem process revealed that night shift nursing staff did not consistently provide quality BSR; in fact, some nurses did not perform BSR at all. Instead, shift reporting was undertaken away from the patient bedside, in hospital hallways or at nursing stations. This project recognizes the likely obstacles revealed via a nursing survey administered prior to implementation, including nurse mindsets, views, and beliefs pertaining to performing BSR. Nursing workers believe quality BSR performance is contingent on time availability, linguistic obstacles, patient conformity, employee outlooks or resistance, and concerns about Health Insurance Portability and Accountability Act (HIPAA) violations (Boshart, 2016; Ford & Heyman, 2017).

Between-shift nurse reporting involves outgoing nurses handing over charge of the patient to the incoming nurse. Here, it is vital to effectively convey crucial details regarding the patient care plan and current health status. BSR performance facilitates participation by patients and their families in care. It also facilitates engagement in information sharing, which guarantees identification and alignment of the objectives of the patient, the healthcare team, and the patient's family. BSR enhances patient satisfaction, lowers patient fall rates, reinforces the patient–nurse relationship, reduces hospitalization duration, reinforces collaboration, and improves nursing staff prioritization and accountability at shift commencement.